Leticia Medina v. Social Security Administration, Commissioner

[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
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No. 15-12343
Non-Argument Calendar
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D.C. Docket No. 4:13-cv-01858-SLB
LETICIA MEDINA,
Plaintiff-Appellant,
versus
SOCIAL SECURITY ADMINISTRATION, COMMISSIONER,
Defendant-Appellee.
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Appeal from the United States District Court
for the Northern District of Alabama
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(January 6, 2016)
Before ED CARNES, Chief Judge, TJOFLAT, and JILL PRYOR, Circuit Judges.
PER CURIAM:
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Leticia Medina appeals the district court’s order affirming the Social
Security Commissioner’s denial of her application for disability insurance benefits.
She challenges the decision of the administrative law judge (ALJ) on several
grounds. First, she contends that the ALJ erred in failing to find that all of her
impairments were severe. Second, she argues that the ALJ did not adequately
explain why he gave little weight to the medical opinions of her physician, nurse
practitioner, and psychiatrist. Finally, she contests the ALJ’s determination that
she could still perform her past work.
In June 2010 Medina filed an application for disability insurance benefits.
Before her purported disability onset date of March 24, 2010, she had worked as a
data entry clerk, case manager, translator, receptionist, admissions clerk, general
clerk, and job placement worker. She alleged that during surgery for thyroid
cancer conducted on March 23, 2010, doctors damaged the nerves in her neck,
limiting her ability to move her neck and arm. She asserted that the nerve damage
caused constant, severe pain in her neck, shoulders, left arm, and lower back,
and — combined with her obesity and depression — prevented her from dressing
on her own, doing housework, cooking, or working. After the Social Security
Administration denied her initial application and her request for reconsideration,
she sought a hearing before an ALJ.
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The ALJ, applying the five-step analysis for determining eligibility for
disability insurance benefits, see 20 C.F.R. § 404.1520(a)(4)(i)–(v), found that,
first, Medina had not engaged in substantial gainful activity since March 24, 2010.
Second, she had severe impairments of obesity and “thyroid cancer status post total
thyroidectomy,” but her depression was non-severe. The ALJ did not classify the
remainder of Medina’s medical issues. Third, her impairments did not meet or
equal one of the impairments listed in the Code of Federal Regulations. Fourth,
she had the residual functional capacity to perform light work with certain
adjustments (for example, she could not use her left arm for significant lifting or
carrying on a regular basis, and she had very little horizontal or vertical movement
in her cervical spine). But the ALJ concluded that, despite her limitations, she was
capable of performing her past relevant work as a data entry clerk and as a
translator, as that work did not require the performance of activities precluded by
her residual functional capacity. Because the ALJ’s determination that Medina
could perform her past relevant work meant that she was not disabled, he did not
proceed to the fifth and final step set out in § 404.1520(a)(4)(v).
The Social Security Appeals Council denied Medina’s request to review the
ALJ’s decision. Medina then filed a civil action in the district court, which
affirmed the ALJ’s decision. This is her appeal.
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Where the ALJ denied benefits and the Appeals Council denied review of
that decision, “we review the ALJ’s decision as the Commissioner’s final
decision.” Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001). “We review
the Commissioner’s factual findings with deference and the Commissioner’s legal
conclusions with close scrutiny.” Id. That means “[t]he Commissioner’s factual
findings are conclusive if they are supported by substantial evidence, consisting of
such relevant evidence as a reasonable person would accept as adequate to support
a conclusion.” Id. (quotation marks omitted).
I.
Medina first contends that the ALJ erred at the second step of the five-step
analysis set out at 20 C.F.R. § 404.1520(a)(4)(i)–(v), because he did not find that
her depression, lower back pain, neck pain, shoulder pain, left arm weakness, and
limited range of motion at the cervical spine, constituted severe impairments. Step
two of the test merely “acts as a filter.” Jamison v. Bowen, 814 F.2d 585, 588
(11th Cir. 1987). In other words, “if no severe impairment is shown the claim is
denied, but the finding of any severe impairment, whether or not it qualifies as a
disability and whether or not it results from a single severe impairment or a
combination of impairments that together qualify as severe, is enough” to proceed
with the rest of the five-step analysis. Id. Thus, even if Medina’s other conditions
should have been categorized as severe impairments, any error was harmless
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because the ALJ determined that her obesity and “thyroid cancer status post total
thyroidectomy” were severe impairments, allowing him to move onto step three of
the test. See Diorio v. Heckler, 721 F.2d 726, 728 (11th Cir. 1983) (holding that
the complained-of error was harmless because it did not impact the step being
challenged); see also 20 C.F.R. § 404.1520(a)(4).
Medina appears to argue that the purported error at step two affected the
ALJ’s analysis at step four because the ALJ failed to consider the combined effect
of her severe and non-severe impairments in determining whether she was capable
of performing her past work. But the ALJ stated that he had considered all of
Medina’s symptoms and all opinion evidence, and his ruling included a discussion
of the degree of limitation caused by Medina’s depression, her subjective
allegations of pain, and her mobility limitations, in assessing her residual
functional capacity. See Jamison, 814 F.2d at 589–90; Walker v. Bowen, 826 F.2d
996, 1001 (11th Cir. 1987).
II.
Medina next contends that the ALJ did not adequately explain the weight
given to the medical opinions of physician Dr. Jane Teschner, nurse practitioner
Carol James, and psychiatrist Dr. David Wilson, all of whom, she argued, should
have been considered treating sources. The ALJ is required to give the medical
opinions of treating sources substantial or considerable weight absent good cause.
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Winschel v. Comm’r of Soc. Sec., 631 F.3d 1176, 1179 (11th Cir. 2011); see also
20 C.F.R. § 404.1527(c)(2).
Contrary to Medina’s contention, James and Dr. Wilson were not treating
sources. James cannot be considered a treating source because nurses are not listed
in the regulations as acceptable medical sources. See 20 C.F.R. §§ 404.1502,
404.1513(a), (d). And Dr. Wilson is not a treating source either, because he did
only one examination of Medina and did not have an ongoing treatment
relationship with her. McSwain v. Bowen, 814 F.2d 617, 619 (11th Cir. 1987); 20
C.F.R § 404.1502.
In giving James’ medical opinion little weight, the ALJ noted that she (a
nurse) is not a medical doctor or specialist, and correctly concluded that her
conclusory statement that Medina was disabled and unable to work was an opinion
reserved to the Commissioner. See 20 C.F.R. § 404.1527(d)(1). The ALJ gave
Dr. Wilson’s opinion only “some” weight because other medical evidence showed
that Medina had only mild symptoms of depression and her depression was
generally well controlled with medication. Indeed, two other doctors reported that
Medina had no psychiatric issues, a nurse reported that Medina did not show
evidence of depression, and Medina self-reported that she was “doing fine with
aspects of [her] depression.” That is certainly “relevant evidence [that] a
reasonable person would accept as adequate to support a conclusion” that
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Dr. Wilson’s medical opinion was not supported by the record as a whole and,
therefore, was not entitled to great weight. See Doughty, 245 F.3d at 1278.
On the other hand, Dr. Teschner, one of Medina’s physicians, was a treating
source, and as such, the ALJ was required to give her medical opinion substantial
or considerable weight absent good cause. Winschel, 631 F.3d at 1179; see also 20
C.F.R. § 404.1527(c)(2). Good cause exists “when the: (1) treating physician’s
opinion was not bolstered by the evidence; (2) evidence supported a contrary
finding; or (3) treating physician’s opinion was conclusory or inconsistent with the
doctor’s own medical records.” Winschel, 631 F.3d at 1179 (quotation marks
omitted). The ALJ explained that he gave Dr. Teschner’s medical opinion little
weight because her opinion was based on Medina’s subjective complaints and she
did not conduct any objective tests. That articulation of reasons is sufficient to
show good cause, especially in light of the contrary medical evidence of three
other examining physicians, whose records showed that Medina suffered less pain
and had more mobility than Dr. Teschner’s reports indicated. See id.
III.
Medina’s final contention is that substantial evidence does not support the
ALJ’s finding that she could not perform her past relevant work because the ALJ
improperly relied on an outdated residual functional capacity assessment
completed early in her period of purported disability. But the ALJ did not rely on
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the contested residual functional capacity assessment; instead, he used his own
residual functional capacity assessment, which differed from the earlier
assessment, in determining what type of work Medina could still perform.
Substantial evidence supports the ALJ’s determination that Medina was not
disabled.
AFFIRMED.
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